A Nutrition Intervention for Migraines – New Study Indicates Elimination Diet May Work

Dietary modification to eliminate triggers and help prevent migraine attacks is nothing new. Many of us take dietary supplements, such as magnesium and/or CoQ10, at the advice of our doctors in the hopes of reducing our migraines. Most of us also have some foods or drinks we avoid on a regular basis because ingesting them nearly always guarantees we’ll be laid up in bed with the lights out before dark.

Of course, everyone’s triggers are different, and that can make figuring out which foods – if any – trigger a particular person’s migraines exceedingly difficult, especially when compounding triggers means a food might trigger an attack one day but might not another.

To get around these difficulties, some migraine treatment plans recommend following a complete elimination diet, in which you remove from your diet all of the foods and chemicals most often associated with migraine and then gradually re-introduce them one at a time to see which ones cause an increase in migraine severity and/or frequency.

Foods and chemicals most often excluded in elimination diets include:

Caffeine

Alcohol

Aged cheeses

Chocolate

Dried fruits

Deli meat

Hot dogs

Sausage

Jerky

Pepperoni

Corned beef

Soy

Nuts

Citrus fruits

Vinegar

Tyramine

Phenylethylamine

Nitrates

Nitrites

MSG

Tannins (found most often in red-skinned apples and pears, red wine, and tea)

Sulfites

Aspartame (aka NutraSweet and Equal)

Yeast extract

Hydrolyzed or autolyzed yeast

Hydrolyzed vegetable protein (HVP)

Hydrolyzed plant protein (HPP)

Sodium caseinate, and

Kombu extract

If that list overwhelms you, you’re not alone.

Many migraineurs balk at the idea of following a complete elimination diet, thinking it’s too hard to stick to, especially in today’s busy world where few of us find the time to cook on a regular basis. Some also feel that there simply isn’t enough evidence to prove such a diet works. A new study, presented at this year’s American Academy of Neurology annual meeting in Philadelphia and published in April in Neurology, may help change that.

In “A Nutrition Intervention for Migraine,” Drs. A. Bunner, J. Gonzalez, F. Valente, U. Agarwal, and N. Barnard examined the effects of a low-fat, plant-based dietary intervention plan on migraine severity and frequency in chronic migraineurs. The study’s hypothesis was that a low-fat vegan diet would improve migraine pain more effectively than a dietary supplement regimen. The results, while not perfect, demonstrate that dietary modification in general and elimination diets in particular may indeed work to reduce the frequency and the intensity of migraine attacks.

The authors recruited 42 chronic migraineurs from the Washington, D.C. area to participate in the study. Once recruited, the migraineurs were randomly assigned to receive either a dietary instruction plan or a dietary supplement plan. The participants then followed the plan for 16 weeks.

Once the 16 weeks were over, the participants underwent a 4-week “washout” period during which time no treatment was given. Following the washout period, the participants were given the other treatment plan (either the dietary supplement or the dietary instruction plan, whichever they didn’t get the first time). They then followed it for 16 weeks.

“During the diet period, a low-fat vegan diet was prescribed for 4 weeks, after which an elimination diet was used to enable participants to identify possible specific pain trigger foods,” stated the authors in the study’s abstract. (The dietary supplement plan featured a mixture of omega3 and vitamin supplements.) “Dietary intake, headache number, headache intensity, visual analog pain measurements, body weight, and plasma lipid concentrations, were assessed at the beginning, midpoint, and end of each 16-week period.”

According to the study, participants reported significantly more improvement (p<0.05) during the dietary instruction period than during the dietary supplement period in visual analog pain scale, total cholesterol, LDL cholesterol, and body weight. Significant decreases in headache intensity and frequency were also reported during the diet period, but the results “did not reach statistical significance when compared with the supplement period.”

These results seem to indicate that an elimination diet may indeed act as a migraine preventative, perhaps even more so than regularly prescribed dietary supplements, if migraineurs start by eliminating all high-fat foods and animal products from their diets, and then gradually reintroduce them one at a time over the course of many weeks. The authors seem to agree.

“These results demonstrate the promise of a nutritional approach to migraine treatment. [Still] Further studies are needed to enable dietary pain triggers to be isolated from other triggers such as stress and hormonal changes,” stated the authors in their conclusion.1,2

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Comments

Actually, the study confirms my own experience this year with about 6 months on a vegan diet (but not the kind of low-fat vegan diet that Neal Barnard, one of the study doctors, advocates) – the diet didn’t reduce my overall frequency or intensity (especially in times of stress, which I was experiencing a more-than-usual high level during this time) but it did make me feel overall physically better. However, the last few months, I was dealing with what are probably my biggest migraine triggers – international plane travel, spending time with emotionally abusive, mentally ill family, making spontaneous decisions, lots of stress and anxiety – and was vegan only about 60%-70% of the time. I expected to have more frequent and intense migraines than usual but the opposite happened – I had only a few and they were minor ones that lasted only about half a day at most and sometimes just a few hours.

So now I’m not so sure that a vegan diet, while it does make me feel overall better, is really doing much for my migraines.

Ive been following a vegan diet for about three years now. During this time I also started Topamax as a preventative. It is hard to say what I can attribute to the diet and what I can to the drugs, but my migraines have been really under control, especially the last couple of years. I have only been getting maybe one significant migraine a month.
Topamax vegan to disagree with me and I am currently weaning off it. I have started getting regular migraines again now that my dose is down to 25mg per day; however, they are much less severe than before I was medicated or before I began a vegan diet.
The diet was very easy to maintain once I understood what my body needed and I feel like although it is definitely not a cure on its own, it HAS made a major difference in the severity of my attacks.
Looking at that list, there are still a few on there that I eat regularly or sometimes… I think it might be a worthwhile experiment to cut those out too for a while as I try to go drug free (except my ritzatriptan – I still need that in the bag for emergencies!!) for at least a couple months.

As soon as I read their conclusion (a vegan low-fat diet may be useful), the ridiculously small study group, and location I had only one thought- Physicians Committee For Responsible Medicine. And sure enough, check the study here where they list their affiliations http://www.neurology.org/content/82/10_Supplement/P6.213

The agenda of the PMRC is to promote a vegan low-fat diet for just about everything out there. I am not saying that this type of diet is not helpful for some people in some situations. I have certainly tried elimination diets and am currently trying another one for a specific item to see if that helps control my migraines and I know many people that have been helped by them. I am saying it is a bit tired, and predictable, that they come to the same conclusions with such deplorably small study groups over and over and go around trumpeting it as some revolutionary new conclusion that then gets reported everywhere.

I can’t help but agree. When I saw N. Barnard listed as one of the study doctors, I pretty much knew right away that it was the low-fat vegan diet they were studying and not another type of vegan diet. It’s true that PCRM does have a very specific and aggressive agenda in promoting this diet and I also agree that this is not to say that it hasn’t helped many people with many illnesses. But I totally agree that it isn’t the cure-all that PCRM and other like-minded doctors and groups try to make it out to be.

I agree: it was a very small study and that means the results aren’t terribly generalizable. However, it does give some more food for thought toward the idea that dietary modification can work for some people, and the idea that it may work as well as or better than added supplements is interesting. I’m looking forward to following this field of study as it develops further.

Jamie,
Food choices are important for a variety of health reasons. Like you, I do my best to avoid MSG and corn syrups, though many of the other things that bother many chronic migraineurs don’t affect me. I’m glad you’ve found a diet that works for you. Thank you for reading!

Jamie, You make a LOT of assumptions on my diet. I don’t eat Hostess Twinkies or any of the rest. I won’t say my diet is 100% healthy, but my husband & I try to eat a very low-carb, low-grain, low processed-foods diet. I don’t look like “death warmed over” between my attacks. I spent a wonderful day today down at the beach, swimming in the ocean and enjoying a completely migraine-free day. In fact, this is my 6th day down here and I’ve only had 3 minor migraines this whole time, none of which impacted my ability to enjoy myself. It’s been a great week for me so far! I did all this while still eating meat and store-bought foods because my family & I happen to be on vacation right now.

I find it amazing that after 37 years, you still feel presumptuous enough to assume you have the answers for everyone else. If you knew migraines as well as you claim, then you would realize that even those of us who suffer from Chronic migraines varies in what affects us and how we are affected. Some people find chiropractic treatment to be beneficial, but it did not help me.

Food is a big part. I do agree that we eat too many foods with hormones and chemicals. Unfortunately, my husband & I just bought a home that is pretty out in the middle of no where. We use to live very close to some whole-food stores and organic stores. Now the closest grocery store is 20 minutes away and its selection of organic things is very limited. I simply do not have the time or energy in my life to drive over an hour round trip for groceries. We do the best with what we have, but I think Vegan is over kill for most people. Also, it can lead to other health concerns. You adjust to them well, but not everyone is as dedicated as you are.

I would like to see more research done on not only low-fat vegan but also non-processed whole foods. There are a lot of foods sold as vegan but they are processed full of chemicals and are virtually junk food.

I tried elimination diets and got nowhere. And I think this is why —-
“Of course, everyone’s triggers are different, and that can make figuring out which foods – if any – trigger a particular person’s migraines exceedingly difficult, especially when compounding triggers means a food might trigger an attack one day but might not another.”

I believe that “compounding triggers” or what I call toxic overload, have a great deal to do with my migraines. That said my biggest trigger is odors. Fortunately food odors besides cinnamon and vanilla don’t bother me.

Anyway, I have eaten a whole foods plant based diet similar to McDougall and his crowd only I’m more careful about processed foods. Plus taking Magnesium and CoQ10. After several months I notice the acute week long attacks hadn’t happened for some time and my daily pain level is greatly diminished. Great improvement.

Am still experimenting because of the odor thing. The odors do not need to be strong to affect me. Going out shopping or socializing for a few hours pollutes my body, clothes and hair. The clothes come off to be hung outdoors to air out. The hair is a bigger problem as many smells do not wash out. I will feel polluted for 1-3 days after. Am almost 70 but I’ll never give up. I still make the most of my life no matter. Have recently added turmeric spice to meals and boswellia supplement to see what this might do. Keep a healthy body and spirit.

Luna,
I am like you as well. When I first went to my Neuro, he wanted to know what “food triggers” I had. I can honestly say that to this day, there are very few food triggers I have noticed. Red wine, but only if I have more than 1 glass, and MSG are the only certain triggers that I have with food. In fact, for me Chocolate & Caffeine are actually helpful during a migraine to relieve some symptoms.

Like you, odors are a MAJOR MAJOR trigger for me. Unlike you, vanilla is one of those triggers, along with cigarette smoke (fresh & old as in on someone’s clothes), fruity body/hand lotions, Perfumes/musks/body sprays etc…

The thing is, people surround themselves in chemicals of smell. Shampoo, lotion, arm deodorant, body spray, LAUNDRY DETERGENT (Gain makes me puke) all of these chemically synthesized with a different smell. It amazes me the number of people who talk to me and say, “Yeah I don’t wear that smell stuff” while I’m sitting there holding my breath because they stink so bad.

If more research is done, and my Neuro recommends it then I will, or course, try it. Anything to get relief. However, 42 participants is a VERY small pool of people and they were all local to the Washington DC Area. I’ve read a lot of other feed back about elimination diets working at first and then failing over the long term. I am also not sure how reasonable it is to maintain such a diet in today’s society.

Processed foods are a big no-no for me, so I agree. I’ve also recently cut out corn, which isn’t commonly listed as a migraine trigger, and I’m pretty sure it’s helping. Only time will tell of course. I also supplement with Magnesium and CoQ10. I haven’t heard of using turmeric for migraine relief. I’ll have to look into that.